Of CMV-infected children who are asymptomatic at birth, 8% to 15% will develop hearing loss and psychomotor delay later in life.20 Should CMV Hyperimmune Globulin or Antiviral Agents Be Recommended in Pregnancy? Because of the poor prognosis associated with primary maternal CMV diagnosed early in pregnancy, sellekchem elective termination should be discussed as an option. Women who wish to continue the pregnancy may be offered one of several medical therapies; however, these should all still be regarded as investigational. Ganciclovir has been used extensively in newborns with symptomatic CMV infections. In such newborns, a 6-week course of IV ganciclovir has been shown to significantly reduce the incidence of hearing loss, although some newborns will experience neutropenia.
21 Information on the safety and efficacy of ganciclovir in pregnancy, however, is extremely limited. Animal data have shown an increased risk of fetal malformations when ganciclovir was used in higher than normal doses in pregnancy, although case reports in humans suggest no increased risk of malformations.5 In a small pilot study, oral valacyclovir was administered to 21 pregnant women with confirmed CMV-symptomatic fetuses. The medication was well tolerated and a decrease in CMV viral load was noted in the cord blood of the treated fetuses; however, given the small sample size, no clear improvement in perinatal outcome could be demonstrated.22 Further studies are necessary to determine the safety and efficacy of antiviral agents in the treatment of CMV during pregnancy.
In vitro and animal studies suggest that CMV hyperimmune globulin (HIG) may be effective in minimizing the damage caused by CMV infection. For example, when pregnant guinea pigs were exposed to CMV followed by administration of a neutralizing antisera, fetal survival increased significantly as compared with those animals who did not receive passive immunization, and a similar reduction was noted in fetal infection, placental inflammation, and IUGR.23,24 CMV HIG consists of enriched CMV-specific immunoglobulins and has been studied extensively in post-transplant patients for CMV prophylaxis.25,26 It is marketed in the United States as Cytogam? (CSL Behring, King of Prussia, PA). Nigro and colleagues27 conducted a multicenter, prospective study of 181 pregnant women with primary CMV infection.
Of these women, 79 underwent amniocentesis and 55 were found to have CMV-positive amniotic GSK-3 fluid. Of these, 31 women elected to receive 200 U/kg CMV HIG administered monthly, 14 women elected not to receive HIG, and 10 women elected to terminate the pregnancy. Only 3% (1/31) of fetuses who received HIG were symptomatic at birth as compared with 50% (7/14) of the infants whose mothers declined HIG. In this nonrandomized study, administration of HIG to the mother and the presence of fetal ultrasound abnormalities prior to treatment were important predictors of fetal outcome.